Provider Demographics
NPI:1154133635
Name:GRACE HANDS HOME CARE LLC
Entity type:Organization
Organization Name:GRACE HANDS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAVANISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAKOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-550-7478
Mailing Address - Street 1:8004 CREEKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6514
Mailing Address - Country:US
Mailing Address - Phone:505-550-7478
Mailing Address - Fax:
Practice Address - Street 1:8004 CREEKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6514
Practice Address - Country:US
Practice Address - Phone:505-550-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care